1912907429 NPI number — CONSTANCE LEE OD

Table of content: CONSTANCE LEE OD (NPI 1912907429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912907429 NPI number — CONSTANCE LEE OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
CONSTANCE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912907429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
940 COMMONWEALTH AVE SUITE 2
Provider Second Line Business Mailing Address:
NEW ENGLAND EYE INSTITUTE
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-262-2020
Provider Business Mailing Address Fax Number:
617-236-6323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 COMMONWEALTH AVE
Provider Second Line Business Practice Location Address:
#2A
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02215-1274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-262-2020
Provider Business Practice Location Address Fax Number:
617-236-6323
Provider Enumeration Date:
07/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4100 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: W16249 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 30548 . This is a "BMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 31511 . This is a "NHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: MA4400 . This is a "EYEMED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 976490 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA20532 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 334651 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2077157 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0334651 . This is a "MASS HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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